Healthcare Provider Details

I. General information

NPI: 1679689996
Provider Name (Legal Business Name): LONNY W SMITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

IV. Provider business mailing address

2432 GENESYS PKWY
GRAND BLANC MI
48439-8069
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-7000
  • Fax:
Mailing address:
  • Phone: 810-606-6499
  • Fax: 810-606-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704169618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: